Abstract 458P
Background
Biological agents are increasingly added to combination chemotherapy (ComboCTx) in the care of gastroesophageal cancer (GEC), posing a challenge for patient selection. We investigated which real-world patients are treatable and eligible for ComboCTx.
Methods
We retrospectively analysed electronic health records for all GEC patients referred for medical treatment consideration at Tampere University Hospital (TUH) 2016-2022. Chi-square test and Kaplan-Meier estimates were used.
Results
During 7 years 577 patients were diagnosed with GEC in TUH district and 313 (54%) were referred for medical treatment consideration, and CTx given to 220 (70%). Demographics are presented in the table. ComboCTx was given to 84% and single agent (SingleCTx) in 16%. Treatment intent in ComboCTx and SingleCTx was curative in 53% and 29%, respectively, with median overall survival (mOS) 34 and 11 months, and palliative in 47% and 71% with mOS 10 and 11 months. Trastuzumab was added to palliative treatment in 13%. Other treatment without CTx, as surgery, chemoradiation or radiotherapy was given to 18%, mOS 43 months. Best supportive care only (BSC) was given to 12% with mOS 2 months. Ineligibility for new drugs (study inclusion/exclusion criteria not met) among CombCTx patients was 48% (90/186) due to ECOG PS >1 in 45, Charlson ≥4 in 9, non-adequate organ function in 36, second cancer within 5 years in 29, and not adenocarcinoma or squamous histology in 18 (histology missing in 74). Table: 458P
Patient characteristics
| All | ComboCTx | SingleCTx | Other | BSC | |
| 313 (100%) | 186 (59%) | 34 (12%) | 55 (18%) | 36 (12%) | |
| Curative treatment intent | 48 % | 53 % | 28 % | 73 % | 0 % |
| Male sex | 72 % | 76 % | 67 % | 69 % | 64 % |
| Age >75 years | 27 % | 15 % | 58 % | 44 % | 31 % |
| Gastric primary | 55 % | 53 % | 61 % | 62 % | 50 % |
| Primary not resected | 57 % | 50 % | 75 % | 40 % | 100 % |
| Metastatic disease | 38 % | 35 % | 44 % | 22 % | 72 % |
| Other cancers within 5 years | 20 % | 16 % | 33 % | 27 % | 14 % |
| ECOG >1 | 44 % | 24 % | 81 % | 24 % | 97 % |
| Charlson ≥4 (n=310) | 15 % | 11 % | 14 % | 24 % | 22 % |
| BMI<18.5 (n=282) | 5 % | 3 % | 12 % | 0 % | 12 % |
| Non-adeno/SCC histology (n=238) | 17 % | 12 % | 24 % | 24 % | 29 % |
| Non-adequate organ function (n=252) | 36% | 28 % | 35 % | 38% | 66% |
Conclusions
In our half million district more than half of all unselected patients diagnosed with GEC were considered for CTx and 70% of them received it. ComboCTx was given to 84% of CTx treated with survival in line with literature. Only half of the patients are eligible for addition of new biological drugs, if trial inclusion/exclusion criteria are used in the implementation.
Clinical trial identification
MJ006N, R19628S.
Legal entity responsible for the study
Tampere University Hospital.
Funding
Tampere University Hospital OOO project.
Disclosure
P.J. Osterlund: Financial Interests, Personal, Advisory Board, Also invited speaker: Amgen; Financial Interests, Personal, Advisory Board, Also invited speaker: AstraZeneca, MSD, BMS; Financial Interests, Personal, Advisory Board, Also invited lecturer: Bayer, Pierre Fabre; Financial Interests, Personal, Invited Speaker: Eisai, Fresenius Kabi, Imedex; Financial Interests, Personal, Advisory Board: Merck, Sanofi, Incyte, Daiichi Sankyo/AstraZeneca, Eisai, Jansen Pharmaceutica; Financial Interests, Personal, Invited Speaker, Roche Finland and Sweden: Roche; Financial Interests, Personal, Invited Speaker, No compensation for advisory boards: Servier; Financial Interests, Personal, Invited Speaker, Also via Medicom: Nordic Drugs/Group; Financial Interests, Personal, Expert Testimony, FIMEA expert testimony: BMS; Financial Interests, Personal, Invited Speaker, Nordic guidelines committee: Danone; Financial Interests, Institutional, Research Grant: Amgen, Servier, Nordic Drugs/Group; Financial Interests, Institutional, Invited Speaker: Incyte, Roche, Pfizer; Non-Financial Interests, Member: Colores patient advocacy group; Non-Financial Interests, Member, Board member: Finnish Cancer Society. J. Kontiainen: Financial Interests, Personal, Training, Travel costs: Novartis. K.I. Lehtomaki: Financial Interests, Institutional, Research Grant: Amgen, Merck, Roche, Sanofi, Servier, Eli Lilly; Financial Interests, Personal, Expert Testimony: Bayer, Amgen; Financial Interests, Personal, Expert Testimony, Invited speaker: Roche; Financial Interests, Personal, Invited Speaker: Servier, Pfizer, AstraZeneca. All other authors have declared no conflicts of interest.